Biking Through Class for Better
Behavioral Outcomes

One catch-22 in the treatment of children with behavioral disorders is that they demonstrate low participation in aerobic exercise, yet exercise has been shown to improve mood and behavior in children.

In an effort to move past this conundrum in the treatment of children with behavioral disorders, one randomized controlled study developed a new strategy to try and engage such children in physical activity with an eye toward improving their behavioral self-regulation and classroom functioning.

The study enlisted children and adolescents with “complex BHD,” or complex behavioral health disorders, meaning behavioral disorders with root causes in several genetic and environmental factors.

In the study, children with mental health disabilities attending a therapeutic day school were enrolled in an aerobic “cybercycling” physical education curriculum. This type of stationary bike combines the basic pedaling machine with virtual reality tours, competitive avatars or video game features. The 14-week study of PE classes looked at both the chronic effects (over seven weeks) of exercise intervention and the acute effects a bout of exercise might have on behavior on any given day. A third factor under scrutiny was the overall programmatic effects the exercise intervention itself might have, as distinguished from the effects of the exercise.

The researchers compared the students’ behavioral self-regulation scores when participating in the intervention curriculum with scores assessed during periods of standard, nonaerobic PE curriculum. The control in this case then, was not a separate group of subjects unexposed to the exercise intervention, but the periods of time (half, or seven weeks) when the same students were participating in standard PE instruction without an aerobic component.

During the intervention period, children used cybercycle stationary bikes twice per week during 30- to 40-minute PE classes. During the control period, children participated in standard nonaerobic PE. The data were analyzed to assess relationships between intervention exposures and clinical thresholds of behavioral outcomes, accounting for both individual and classroom random effects.

The study found that children experienced 32% to 51% lower odds of poor self-regulation and “learning-inhibiting disciplinary time out of class” when participating in the intervention as compared to the control condition, results the authors report as both clinically and statistically significant. Effects were appreciably more pronounced on days that children participated in the aerobic exercise, but carryover effects were also observed.

On days when children participated in the intervention cybercycling class, odds of disruptive levels of behavioral dysregulation declined between 71% and 76% relative to the control condition. Although there seemed to be chronic exercise and programmatic effects of this intervention on behavioral self-regulation and classroom functioning even on days when children did not bike, acute exercise appears to be the primary driver of the intervention effect.

The authors write, “This school-based exercise intervention may significantly improve child behavioral health without increasing parental burden or health care costs, or disrupting academic schedules.”

In addition to aerobic exercise, the cybercycling PE classes may hold several other advantages over standard PE programming. They require fewer transitions, which are often challenging to children with BHD. Also, the cybercycling PE allowed students to avoid peer judgments of performance, because other students could not see their performance data unless they shared it. Standard PE classes confer their own benefits, however, including motor skill acquisition, team sports practice and socialization.

Pediatrics, 2017, Vol. 139, No. 2, http://pediatrics.aappublications.org/content/139/2/e20161985

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